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Innovations in Health Insurance and Why They Matter

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Health insurance is evolving to give consumers more choice, more transparency and more perks to make it easier to stay healthy and fit.

Americans aren’t sure what will happen to the Affordable Care Act (ACA) now that President-elect Donald J. Trump has his hands on it, but they still need health insurance. The ACA made it possible to purchase individual plans, giving consumers plenty of choices. But today’s insurance policies are evolving, and there are a few innovations that could make the difference when wading through all of the options.

In the past, people got health insurance to avoid financial ruin in the event of an unexpected illness or injury. These days, there are more reasons to get a plan. Under the ACA, you may have to pay a tax penalty if you don’t want insurance. You also may not be able to get coverage until an open enrollment period. And you can miss out on free preventative care.

Health Insurance has Changed

A few innovations in health insurance are impacting the type of coverage you can get today:

1. A Smarter Plan

Most of the plans you see today are named after different metals: Bronze, silver, gold, and platinum. For the most part, bronze and silver plans cost less each month but they have higher deductibles. That means you’ll have to reach a certain limit for the plan to actually kick in. These can be ideal for younger people who do not have chronic health needs.

Gold and platinum plans cost more every month, but they have low or nonexistent deductibles so you don’t pay as much upfront when you need care. If you’re looking for the cheapest plan but understand that you may have to pay some medical bills during the year, go for a lower-tier plan. You may qualify for a cost-sharing reduction, so even a silver plan can have a reasonable deductible.  

In an effort to prevent people from having to pay hefty deductibles before they receive coverage, insurers are getting creative with plan design to ensure members get the care they need. Some include plans [LC1] [LP2] that offer copays for routine services, which means that members pay a flat fee for a service before reaching the deductible. One of the biggest criticisms of the ACA is that you have to pay thousands in a deductible in order to receive coverage, so plans like these could provide significant cost savings on doctor’s visits and medications throughout the year.

2. Transparency and User Experience Matter

Now that people can choose their own health plan, insurers are going out of their way to deliver. But better tools for consumers often means lots of problem solving behind the scenes.

Insurers know that people want features such as a mobile app that makes it easier to find doctors, medical facilities and pharmacies in their network. But in addition to building the app, insurers must ensure their directories are always up to date. Earlier this year, the insurance startup Oscar started crowdsourcing to obtain cleaner provider data, allowing members to suggest an edit if they find an incorrect address or phone number in the directory.

Websites and apps aren’t simply for getting the contact number or a claim form; you can now check your health history to see when you last filled a prescription or saw a particular doctor. Insurers are also listing cost estimates in order to help members weigh costs. This can help to avoid surprise out-of-pocket bills. Doing this well requires insurers to coordinate and simplify rates and claims data behind the scenes.

3. Extras to Keep You Well

Some health insurance plans offer incentives and perks like fitness rewards and free or low-cost telemedicine. Oscar, for example, pays members $1 every time they hit their daily step goal. After the rewards rack up, members can cash out for an Amazon gift card.

Telemedicine helps patients and insurers save money on non-emergency care. Not only is a visit to the ER time consuming and expensive, it’s often not even necessary. A 2013 Academic Emergency Medicine report found that 27 percent of emergency visits that cost more than $1,000 could be avoided by using telemedicine services. For example, Oscar’s plans allow members to talk to a doctor 24/7 for free, which is a good way to decide with the help of an MD if a trip to the ER is the right call.

These are just some of the ways the ACA is creating a marketplace that rewards carriers who offer a more patient-driven healthcare experience. While it’s still evolving, knowing what’s out there can better equip patients to take charge of their health with a health insurance plan that delivers true value.

Enroll Now for 2017 Coverage

Make sure you get coverage by December 15, 2016 so your coverage can begin on January 1, 2017. Contact Oscar.